Anaesthesia and Critical Care Medicine Journal (ACCMJ)
ISSN: 2577-4301
Research Article
The Impact of Various Anesthetic Techniques on Cerebral
Oxygenation during Spinal Surgery Performed in a Prone Position
with Controlled Hypotension
Authors:
Mohamed Daabiss
,
Rashed Al-Otaibi
,
Muteb Al-Otaibi
,
Osama Shalaan
,
Sajjad Shah
and
Majed AlSharif
DOI:
10.23880/accmj-16000242
Abstract
Background: While prone positioning during anesthesia is necessary for certain surgical procedures, it also increases the risk of postoperative neurological complications. This risk is exacerbated by controlled hypotension used to minimize blood loss during spinal surgeries. Monitoring regional cerebral oxygen saturation (rScO2) is essential for maintaining cerebral oxygenation and preventing adverse outcomes like cognitive dysfunction and organ failure. This study aimed to evaluate the effect of different anesthetic techniques on cerebral oxygenation in patients undergoing spinal surgery in the prone position with controlled hypotension.
Methods: Fifty-four patients scheduled for spinal surgery in a prone position with controlled hypotension were randomly assigned into two equal groups, to receive sevoflurane or propofol anesthesia. Data were collected at various intervals: before and after anesthesia induction, post-induction in the prone position, during surgery, and before awakening in the supine position. Parameters recorded included rScO2, peripheral oxygen saturation (SpO2), heart rate (HR), patient state index (PSI), end-tidal carbon dioxide tension (ETCO2), and mean arterial pressure (MAP).
Results: rScO2 levels decreased in both patient groups once positioned in the prone position. However, the rScO2 values were significantly lower in the propofol group compared to the other group (p = 0.025, 0.032 respectively).
Conclusion: The study suggests that propofol as the anesthetic agent may have exacerbated the decline in cerebral oxygenation associated with the transition to prone positioning. Sevoflurane might thus be preferable for patients at risk of compromised cerebral oxygenation.
Keywords: Cerebral; Oximetry; Sevoflurane; Propofol; Controlled Hypotension; Prone
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